Assessment and psychotherapy with women experiencing intimate partner violence: integrating research and practice

Co-location of specialized mental health services in an intimate partner violence advocacy organization

Historically, services for intimate partner violence (IPV) survivors predominantly focused on advocacy, resulting in service gaps for IPV survivors who need mental health care. When mental health services are offered, there are several barriers that limit treatment engagement. To address these gaps, a novel, integrated care model, comprised of psychiatrists, clinical psychologists, and social workers were embedded into the five New York City (NYC) Family Justice Centers (FJCs), to provide free co-located mental health care to adult survivors of IPV alongside the existing advocacy, social, and legal services. This article reports on the evaluation of the Health + Hospitals Family Justice Center Mental Health Program (FJCMHP) via: (i) seven focus groups with FJC clients and staff and Health + Hospitals (H+H) clinicians; and (ii) de-identified online surveys completed by 53 FJC clients and 130 FJC staff. Clients reported increased access to care, with 67.2% seeing a mental health clinician within two weeks of a request, and improvement in symptom relief, including sleep, mood, irritability, reduction in thoughts of self-harm, improved relationships with others, especially their children, and improved self-efficacy in parenting skills. Additionally, FJC staff reported satisfaction with the FJCMHP model, and increased understanding of clients' mental health needs. The evaluation results highlight the feasibility and tolerability of integrated mental health services in a non-medical setting. The evaluation also identifies areas for improvement, as well as the strengths of an integrated, multidisciplinary mental health service program for IPV survivors co-located in a non-medical, advocacy setting.

Continuous Traumatic Stress: Examining the Experiences and Support Needs of Women After Separation From an Abusive Partner

Intimate partner violence causes significant, long-lasting harm to almost one-third (27%) of the world's population of women. Even when women leave abusive relationships, some men continue to exercise control over their ex-partners through psychological control, threats, violence, stalking, and other forms of harassment. In this qualitative study, 52 purposively sampled women who self-identified as victims or survivors of intimate partner violence (IPV) from male partners were interviewed. Data were analyzed with a theoretically informed thematic analysis, supported by Nvivo® software. We found that leaving a violent relationship was a long-term process fraught with difficulty and ongoing risks of psychological harm. The concept of Continuous Traumatic Stress (CTS), first developed to understand the impact of state-sponsored violence and war, was found to be a particularly useful tool for the analysis of the impact of post-separation abuse. Additionally, CTS encourages researchers and practitioners to think anew about resilience-centered approaches to improving protection and access to justice for female victims.

Why Does He Do It? What Explanations Resonate During Counseling for Women in Understanding Their Partner's Abuse?

Intimate partner violence (IPV) is a complex and multifaceted problem gaining increasing attention within mental health research and practice. IPV explanations focus on both individual and systemic levels; however, it is increasingly acknowledged that a single level explanation may not be sufficient. The practices of clinical disciplines may, however, still privilege an explanation at one level over another, which will influence how they work with clients. It is likely that one such clinical group, psychologists, may play a critical role in helping victim-survivors to understand and explain their experiences of IPV. However, we were unable to find any studies focusing on women's perceptions of psychologists' role in this. Additionally, we know little about women victim-survivors' perceptions of why their partners use IPV. To address these gaps, the research question for this study was: What explanations resonate during counseling for women in understanding their partner's abuse? To explore this question, 20 women who had seen psychologists after experiencing IPV participated in semi-structured interviews. The interviews were analyzed using reflexive thematic analysis and three themes constructed from the data. The first two themes, narcissist description was helpful and not all bad all the time, showed that the women found it powerful in their healing processes when psychologists offered the opportunity to discuss their partners individual characteristics as explanations for their use of IPV. The third theme, structural explanations, showed that some of the women also reflected on wider structural contexts. Implications for clinical practice include the potential healing effect when practitioners can move along a continuum of explanation levels, covering both the inner and outer worlds. Implications for research into IPV perpetration are that women hold expertise and insight into individual perpetrators and could make valuable contributions to this field.

Follow-up Evaluation of Psychotherapy Protocols for Women with a History of Intimate Partner Violence: Scoping Review

To investigate the methodological aspects, main results, and limitations of the follow-up evaluations of psychotherapeutic interventions for women with a history of intimate partner violence (IPV). A search was carried out in the SciELO, Scopus, PsycINFO, and Web of Science databases, using the descriptors: (“clinical trial” OR “therapy” OR “psychotherapy” OR “psychological treatment”) AND (“violence” OR “mistreatment” OR “intimate partner violence” OR “domestic violence” OR “conjugal violence”) AND (“women”). 1480 articles were retrieved and after applying the inclusion and exclusion criteria, 11 articles composed the final sample. The majority of the follow-up assessments were carried out through the reapplication of the basic instruments, with the period of 3 months post-intervention being the most used. Sample losses were identified in all the studies analyzed. The limitations and difficulties were associated with the complexity of the target population. This review identified the importance of the follow-up evaluations and the need to adapt them to ensure the effectiveness of the interventions, aiming to reach a larger number of women, strengthen protective aspects, and prevent revictimization.

"Dreaming Undreamt Dreams" in Psychological Counseling with Italian Women Who Experienced Intimate Partner Violence: A Phenomenological-Interpretative Analysis of the Psychologists' Experience

In psychological consultations with women who survive Intimate Partner Violence, it is essential to work on elaboration of the trauma as a complex trauma within the context of a relationship. We consider dreams to be a symbolic-representative process, which requires the right psychic, relational and contextual conditions to occur, and that is hindered when trauma is present. The objective of the present study is to investigate the meanings that psychologists working at anti-violence centers attribute to the clinical intervention with women victims of IPV, with a focus on the area of sleep and dreaming in a traumatic experience, and in the clinical work on the trauma. Twelve female psychologists were interviewed using the Interpretative Phenomenological Analysis methodology. From the analysis of the interviews, three main themes emerged: (1) Day and night, neither awake nor asleep, (2) Anti Violence Centers: setting as a container of emotion? and (3) dreaming undreamt dreams. The study highlights the importance of dreams as an indicator not only of psychic and mental functioning but also of the psychological relationship within a specific context.

Mental health care in the context of intimate partner violence: Survivor perspectives

Experience of violence or abuse from an intimate partner (intimate partner violence, IPV) can result in a variety of psychological and mental health impacts for which survivors may seek psychotherapy or other mental health services. Individuals experiencing IPV may have specific needs and preferences related to mental health care, yet the question of how to best provide client-centered mental health care in the context of IPV has received little attention in the literature. In this article, we report on findings from qualitative interviews with 50 women reporting past-year IPV who received care through the Veterans Health Administration regarding experiences with and recommendations for mental health services. Participants described client-centered mental health care in the context of recent or ongoing IPV as being characterized by flexibility and responsiveness around discussion of IPV; respect for the complexity of clients' lives and support for self-determination; and promoting safety and access to internal and external resources for healthy coping. We discuss findings in terms of their implications for the mental health field, highlighting the need for flexibility in application of evidence-based treatments, improved coordination between therapeutic and advocacy services, and training to enhance competencies around understanding and responding to IPV. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Therapeutic interventions in intimate partner violence: an overview

Intimate partner violence (IPV) is associated with significant morbidity and mortality, and its prevention is a global public health priority. There is strong scientific evidence that suggests IPV and symptoms such as anxiety, depression, post-traumatic stress disorder, substance abuse, chronic pain, etc. are linked. Despite recommendations and various interventions for the treatment of IPV that have been tried in these last 20 years, the rates of recurrence are still too high. Furthermore, there is a lack of research evidence for the effectiveness of the most common treatments provided for victims and perpetrators of IPVs. The purpose of this paper is to present most used, at a global level, therapeutic interventions for women experiencing IPV (as well as treatments for perpetrators). The possibility of building a preliminary theoretical and clinical model is discussed.